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Monday, March 24, 2008


What is Crohn's disease (CD)?

Crohn's disease (CD) is an ongoing health problem that usually causes inflammation deep in the walls of the large intestine (colon) and/or the small intestine. But CD can affect any part of the digestive tract from the mouth to the anus. The inflammation usually causes abdominal pain and diarrhea. In other cases CD may cause constipation.

Crohn's disease is a form of inflammatory bowel disease. There are two main types of inflammatory bowel disease: ulcerative colitis (UC) and Crohn's disease (CD). The diseases are very similar. The main difference between UC and CD is the area of the digestive tract they affect -- CD can occur along the entire digestive tract and spread deep into the bowel wall. In contrast, UC usually only affects the top layer of the large intestine (colon) and rectum.

Nearly half of all CD cases involve both the small and large intestine. About 30 percent of the time, CD occurs in the small intestine, usually in the ileum (the last part of the small intestine that connects to the large intestine or colon). And about 20 percent of the time, CD affects only the colon. Like UC, people with CD also have periods of remission and relapse.

What are the symptoms of Crohn's disease (CD)?

The symptoms of CD depend upon what part of the digestive system is affected. Since CD usually occurs in the last part of the small intestine (ileum) and in the nearby part of the colon, the most common symptoms are pain and tenderness in the abdomen, especially the lower right side and diarrhea. The symptoms of Crohn's disease may be mild or severe. And they often come and go.

Other less frequent signs of CD include:

  • constipation
  • weight loss
  • rectal bleeding
  • low grade fever
  • low levels of iron in the blood (anemia)
  • exhaustion
  • slowed growth and delayed sexual development in childhood cases
What are the complications of Crohn's disease (CD)?

In some people with CD, swelling and scar tissue thicken the bowel wall. This can close off the intestines causing an intestinal blockage. Intestinal blockages cause constipation, bloating, and other problems.
Sometimes the ulcers of CD can break through the walls of the intestine. They then create tunnels or fistulas between the involved intestine and another part of the intestine or nearby organs. Fistulas usually occur in other parts of the intestines or the bladder, vagina, or skin. They are common around the anus and rectum. Mucus, pus, or stool can drain from infected fistulas in this area.

Many people with CD also suffer from nutritional problems. Their damaged digestive systems may not absorb enough proteins, calories, vitamins or minerals. Osteoporosis also is a threat because CD can prevent the body from absorbing enough calcium and vitamin D. Medicines used to treat CD called corticosteroids also increase the risk of osteoporosis. People with CD who do not include enough milk products or vitamin D in their diets have an even higher risk of osteoporosis.

Can Crohn's disease (CD) cause health problems throughout the body?

Yes. CD can cause a number of problems outside of the digestive system including:

  • joint pain or arthritis,
  • inflammation in the eye and mouth,
  • gallstones,
  • several liver diseases,
  • skin rashes,
  • low level of iron in the blood or anemia, and
  • kidney stones.

Some of these problems get better when the Crohn's disease is treated. Others must be treated separately.

How is Crohn's disease (CD) diagnosed?

If you think you might have CD, talk to your doctor. She will use your health history, a physical exam, and several tests to figure out if you have CD.

Tests used to diagnose CD include:

  • Blood tests: A sample of blood is studied in a lab to find signs of inflammation and anemia (low iron levels).
  • Stool sample: A sample of a bowel movement is tested for blood or infection.
  • Upper Gastrointestinal (GI) Series with Small Bowel Follow-Through: The patient drinks a chalky liquid that contains barium. Then x-rays are taken. Barium shows up on x-rays. This allows the doctor to "see" the upper part of the digestive system including the esophagus, stomach, and small intestine. The doctor uses this test to check for signs of CD.
  • Barium Enema: The doctor injects fluid containing a substance called barium into the rectum. Barium allows the doctor to see the colon on an x-ray. Doctors use this x-ray to "see" signs of CD.
  • Flexible Sigmoidoscopy: The doctor puts a thin tube with a light into the rectum. It allows the doctor to check the rectum and the lower part of the colon for signs of CD.
  • Colonoscopy: The doctor puts a thin tube with a light through the rectum and into the colon. This allows her to "see" the lining of the whole colon and check for signs of CD.
  • Computerized Axial Tomography (CT or CAT Scan): The patient drinks liquid containing barium and sometimes has a dye injected into their blood. Barium and this special x-ray dye show up on CT scans. Then the doctor uses a special machine to take many x-rays at different angles from around the body. The doctor studies the images with a computer. CT scans can spot inflammation, narrowing of the intestines, abscesses and blockages.

It often takes a while for doctors to make the correct diagnosis. This is because the symptoms of CD vary and are similar to those of many other problems.

Is inflammatory bowel disease (IBD) the same thing as Irritable Bowel Syndrome (IBS)?

No. Inflammatory bowel disease, including UC and CD, is different from irritable bowel syndrome (IBS). Unlike IBD, IBS does not cause inflammation, ulcers or other damage to the bowel. Instead, IBS is a much less serious problem called a functional disorder. This means that the digestive system looks normal but doesn't work as it should. Symptoms of IBS may include crampy pain, bloating, gas, mucus in the stool, diarrhea and constipation. IBS has also been called spastic colon or spastic bowel.

How is inflammatory bowel disease (IBD) treated?

Doctors treat IBD in order to improve symptoms and decrease the amount of inflammation. Treatment for IBD may include:

  • dietary changes
  • lifestyle changes like stress reduction
  • medicine
  • surgery

The recommended treatment for IBD depends on:

  • the type and severity of symptoms
  • location of disease
  • complications

People who have mild or no symptoms may not need treatment at all. But most people with IBD take medicine to control their symptoms. And many people with severe IBD need surgery to control the disease.

Surgery for Crohn's Disease

About 75 percent of people with CD need surgery at some point in their life. Surgery can relieve symptoms and correct problems like blockages, fistulae or bleeding in the intestine. After surgery, some people are able to stop taking daily medicines for CD.

Surgery can help relieve the symptoms of CD but cannot cure it. The inflammation tends to return next to the part of intestine that was removed. So, people considering surgery for CD should carefully weigh the risks and benefits.

Types of surgery for CD include:

Stricturoplasty In this surgery, the doctor opens up an area of the intestine that has gotten smaller because of CD. The area of the intestine that has narrowed is called a stricture. The doctor does not remove any of the intestine in this surgery.

Small bowel resection In this surgery, the damaged part of the intestine is removed and the two healthy ends are sewn back together.

Colectomy In this surgery, the doctor removes a part of the colon or the entire colon and rectum. The body needs the colon to move and get rid of waste. So after a colectomy the doctor must create a new way for waste to leave the body. This is now usually done by making an opening in the abdomen called a stoma. This hole allows for the drainage of stool from the large or small intestine. A pouch is worn over the opening to collect waste.

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